Critically ill adults in 3 intensive care units were enrolled within 24 hours of
intubation in a randomized controlled clinical trial with a 2 × 2 factorial design. Patients with a
clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded.
Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral
swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control
(usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary
Infection Score (CPIS).